Naloxone Program Stops OD Deaths

A naloxone training program pushed down overdose death rates in communities in Massachusetts, researchers found.

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A naloxone training program pushed down overdose death rates in communities in Massachusetts.

Note that for acute hospitalizations related to overdose, there was no significant association between communities based on high or low implementation compared with no implementation.

A naloxone training program pushed down overdose death rates in communities in Massachusetts, researchers found.

Compared with regions that didn't implement the program, communities with high and low uptake of training saw their overdose death rates fall by 46% and 27%, respectively, Alexander Walley, MD, medical director of the Massachusetts opioid overdose prevention pilot, and colleagues reported online in BMJ.

Overdose has become a leading cause of death by injury in the U.S., largely driven by abuse of prescription opioid painkillers.

Attempts to diminish opioid misuse and overdose have included prescription drug monitoring programs (PDMPs), drug take-back days, and other policies. Another program has been naloxone training for friends and family of patients who are at high risk of overdose, called overdose education and nasal naloxone distribution (OEND).

Naloxone is an opioid antagonist that reverses the effects of opioid overdose. Those close to high-risk patients are taught to look for signs of overdose and to respond quickly with inhaled naloxone.

Between 1996 and 2010, over 50,000 potential bystanders were trained by OEND programs in the U.S., resulting in over 10,000 opioid overdose rescues with naloxone, the researchers said.

To evaluate the impact of the program on overdose deaths and hospitalizations in Massachusetts, Walley and colleagues assessed 19 communities in the state that had at least five fatal opioid overdoses in each of the years from 2004 to 2006, looking at deaths and hospitalizations between 2002 and 2009.

They compared communities where OEND was in place with those where it was not. Overall, 2,912 bystanders were trained, and there were 327 rescues.

Naloxone was successful in 98% of attempts. In the three failed attempts, patients who overdosed got medical care and survived.

The researchers found that opioid-related deaths were reduced in communities that implemented OEND -- whether they had high or low implementation -- compared with no implementation:

High: aRR 0.54, 95% CI 0.39 to 0.76

Low: aRR 0.73, 95% CI 0.57 to 0.91

"OEND implementation seemed to have a dose-related impact, where the higher the cumulative rate of OEND implementation, the greater the reduction in death rates," they wrote.

But for acute hospitalizations related to overdose, there was no significant association between communities based on high or low implementation compared with no implementation.

"While OEND programs should reduce visits to emergency departments and hospital admissions by preventing overdose in the first place, they may also increase visits by encouraging bystanders to engage the emergency medical system, which is an explicit part of OEND curriculums," they wrote.

They noted that the associations were seen independently of effects related to cancer death rates.

The study was limited because it wasn't possible to measure the true population of opioid users in each community, and because overdose fatalities may have been misclassified.

Also, visits to emergency departments and hospital admissions were based on administrative discharge codes that have their own inherent limitations, and overdose rescue attempts may have been under-reported.

The study was supported by the CDC.

The researchers reported no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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